Peter R. Jochimsen

Sexual Functioning Among Breast Cancer, Gynecologic Cancer, and Healthy Women

An investigation was conducted to determine the specific type of sexual functioning deficits and the relationship between global sexual satisfaction and adjustment in two related life areas, the marital relationship and a woman’s body image, for two groups of cancer patients at high risk for sexual difficulties. Analyses revealed that the aspects of sexual functioning for matched samples of breast cancer patients and gynecologic cancer patients that differed from those of healthy women were the frequency of sexual behaviors and the level of sexual arousal. Whereas women’s evaluations of their current sexual life had no relationship to their marital adjustment ratings, analyses suggested that body image disruption may be a prevalent problem for gynecologic cancer patients.

Surgical management of complications of radiation-injured gut

Radiation-injured bowel has been diagnosed in 5.1 per cent of 1,824 patients receiving pelvic or abdominal radiotherapy over the past ten years. Surgical intervention to manage these complications was required in 35 per cent. The type of procedure employed for large and small bowel complications has been evaluated to define guidelines for future therapy.

Effect of benzopyranoperidine, a Δ‐9‐THC congener, on pain

In a double‐blind, 5‐way crossover designed study, single doses of placebo, 2 doses of codeine sulfate (60 and 120 mg), and 2 doses of benzopyranoperidine (2 and 4 mg) were administered orally to 35 patients who required analgesics for chronic pain due to malignancies. Benropyranopyridine is an analogue of delta‐9‐tetrahydrocannabinol and was chosen on the basis of its sedative, hypnotic, and analgesic properties in animals. Pain relief scores indicated a degree of relief of clinical significance witn 120 mg of codeine but no consistent difference between placebo and any other active agent. On the basis of the data, benzopvranoperidine (2 or 4 mg) is not as effective as codeine (120 mg or 60 mg) and no more effective than placebo in relieving pain due to cancer; indeed, pain perception appeared to be augmented by both doses.

The changing attitudes of physicians toward prolonging life.

This follow‐up survey of physicians’ attitudes and practices reveals a changing approach toward the care of terminal patients. It shows that: 1) communication with dying patients is becoming more open, 2) support for the omission of life‐prolonging treatments is increasing, and 3) opposition to the use of death‐hastening measures remains strong. It indicates that the physicians experience with terminal patients and the setting of his practice influence his attitude towards these patients and the approach to treatment.

HORMONAL REGULATION OF THE MENSTRUAL CYCLE IN WOMEN WITH BREAST CANCER: EFFECT OF ADJUVANT CHEMOTHERAPY

The hormonal features of the menstrual cycle determined by measurement of serum LH, FSH, oestradiol, progesterone and prolactin were normal in thirteen breast cancer patients clinically disease free and not taking anti‐tumour therapy. Results of similar studies during seven menstrual cycles in four patients on an adjuvant therapy programme of L‐phenylalanine mustard (L‐PAM) + 5‐flurouracil (5‐FU) also had normal hormonal characteristics after three to fourteen courses of chemotherapy. Amenorrhoea with elevated gonadotrophins occurred after seven courses of chemotherapy in one 48‐year‐old woman. Adjuvant chemotherapy does not appear to result in major alterations in hormone secretion during menstrual cycles of women who continue to menstruate while on therapy.

Adjustment and discussion of cancer: a comparison of breast and prostate cancer survivors.

Supportive conversations may facilitate adjustment among cancer patients early in treatment. However, little is known about how cancer discussion is related to adjustment among long-term survivors of cancer or how gender differences may influence associations between cancer discussion and adjustment. The purpose of this study was to examine possible moderator effects of gender on associations between cancer discussions and adjustment among survivors of breast or prostate cancer. Eighty-eight breast and 88 prostate cancer patients were matched by years post-surgery and stage of cancer and completed measures of cancer discussion frequency, quality of life, and depression. Breast and prostate cancer patients differed on what cancer-related threats were discussed most frequently. In addition, among breast, but not prostate cancer patients, frequent cancer discussion was associated with higher depression and lower quality of life. Frequent discussion of cancer may be an indication of poorer adjustment among breast cancer patients at nearly four years post-surgery. The nature and context of cancer discussions may be important determinants of whether cancer discussions relate to adaptive versus maladaptive outcomes.

Marrow neutrophil reserve after adjuvant chemotherapy for carcinoma of the breast

The hematologic factors of 16 female patients with breast carcinoma who had received adjuvant chemotherapy with L‐phenylalanine‐based programs for two years were compared with those for 13 normal female volunteers of similar age. The findings include significant suppression of the mean hemoglobin level, of leukocyte counts, and of circulating neutrophils and lymphocytes in patients 3–27 months after chemotherapy. Marrow neutrophil reserve studies with prednisolone stimulation again demonstrated significant suppression for the patients who had received chemotherapy. The authors conclude that there is a chronic hematologic toxicity associated with this therapy.

Preparation and administration of chemotherapy. Haematological consequences for hospital-based nurses.

SummaryThis study examined the question of whether previous exposure to cytostatic drugs by oncology nurses was sufficient to lead to haematological phenotypical subclinical abnormalities which had previously been identified in a population of patients who had received chemotherapy as an adjuvant to breast surgery. A comparison of baseline haematological parameters, and the results of a prednisolone stimulation test, was made between nurses regularly coming into contact with such agents and an age-adjusted group of nurses who had not been exposed. Although there is a persistent trend toward lower neutrophils, platelets, monocytes and neutrophil reserves in the nurses who handled antineoplastic agents, a statistically significant decrement in these parameters was not identified. Such a finding should help to reassure individuals who have had similar exposure, but does not negate the importance of following published recommended guidelines for the handling and dispensing of antineoplastic agents.

Radiolabeled Antibody Imaging of Patients with Potentially Resectable Colorectal Adenocarcinoma

Thirty-two patients with potentially resectable recurrent colorectal adenocarcinoma were imaged with the radioimmunoconjugate 111In-satumomab pendetide to determine whether imaging supplies clinically relevant information relating to the extent of disease in patients with different presenting characteristics. Patients included 12 with increasing carcinoembryonic antigen (CEA) without anatomical evidence of recurrence, 13 with radiological abnormalities consistent with apparently isolated metastases, and 7 with recurrence and anatomical abnormalities of unclear significance. 111In-satumomab pendetide imaging detected extrahepatic abdominal and pelvic disease in 16 subjects. Imaging was most informative in patients with recurrent disease and anatomical abnormalities of unclear significance, but imaging of the liver was suboptimal owing to high levels of nonspecific uptake. We conclude 111In-satumomab pendetide imaging can supply clinically relevant information relating to the extent and location of recurrent colorectal adenocarcinoma in patients with extrahepatic abdominal and pelvic radiological abnormalities of unclear significance and in radiologically normal patients with high CEA levels.

Peritoneal venous shunting for the treatment of lymphatic ascites following retroperitoneal lymph node dissection

We report a case of refractory lymphatic ascites following retroperitoneal lymph node dissection and venacavectomy. Placement of a Denver peritoneal venous shunt resulted in resolution of the ascites and marked improvement in the patients nutritional parameters. Shunt occlusion 2 months following placement demonstrated no recurrence of the ascites. This technique may prove useful in the management of lymphatic ascites associated with radical retroperitoneal surgery.